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General NPI Number Information
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NPI Number | 1528363066
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Entity Type | Organization
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Legal Business Name | COLUMBUS STATE UNIVERSITY
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Dates
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Enumeration Date | 01/13/2011
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Last Update Date | 01/13/2011
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Provider Practice Location Address
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Address Line | 4225 UNIVERSITY AVE TUCKER HALL
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City | COLUMBUS
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State | GA
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Zip | 31907-5679
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Country | US
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Telephone | 706-507-8620
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Fax | 706-568-2039
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Provider Business Mailing Address
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Address Line | PO BOX 671205
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City | DALLAS
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State | TX
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Zip | 75267-1205
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Country | US
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Telephone | 866-890-6390
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Fax | 469-735-4640
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Authorized Official
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Title or Position | DIRECTOR, HEALTH SVC
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Name | BECKY TEW
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Credential |
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Telephone | 706-507-8260
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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